1. When readmission was required after major surgery, patients had lower mortality rates if they returned to the same hospital.
2. Readmission was more likely to be to the same hospital if the postoperative complication was surgical in nature.
Evidence Rating Level: 2 (Good)
Study Rundown: Readmission, though undesirable, is often required after major surgery. The patient may be readmitted to the hospital at which the procedure was done or they may be admitted to a different hospital. The investigators in this observational study hoped to investigate the relationship between readmission destination and mortality rate. In order to do this the study examined nearly 9.5 million patients who underwent major surgery. The authors defined major surgery as any one of the following: open abdominal aortic aneurysm repair, infrainguinal arterial bypass, aortobifemoral bypass, coronary artery bypass surgery, oesophagectomy, colectomy, pancreatectomy, cholecystectomy, ventral hernia repair, craniotomy, hip replacement, or knee replacement. Patients who underwent major surgery and required readmission due to some complication were further stratified into those that were readmitted to the same hospital (index hospital) or to a different hospital. The investigators found that patients were more likely to be brought back to the index hospital if the reason for readmission was a surgical complication. Furthermore, in those patients who were readmitted to the index hospital, 90-day mortality was significantly lower. The study was limited by its retrospective data collection, but suggests that readmission destination has significant clinical consequences.
Relevant Reading: Regionalization of care: centralizing complex surgical procedures
In-Depth [retrospective cohort]: This study examined patients who required readmission after major surgery. The investigators examined 9,440, 503 patients. All of those patients underwent one of twelve types of major surgery. The data was gathered from Medicare beneficiaries in the United States. Readmission destination depended on the type of postoperative complication. The investigation found that it was more likely for patients to be readmitted to the index hospital if their postoperative complication was of a surgical nature (23% patients readmitted to index hospital vs 13% of patients readmitted non-index hospital, p<0·0001). When compared to patients admitted to a non-index hospital, patients who were readmitted to the index hospital had significantly lower 90-day mortality rates (odds ratio [OR] 0·74, 95% CI 0·66–0·83). This represents a 26% reduction in risk of 90-day mortality amongst patients readmitted to the index hospital.
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